Month: August 2017

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are ready to explore the final step, Reducing the Potential for Use of Lethal Means.

This final step in the Safety Plan is particularly important when someone considering suicide has developed a plan.  Once someone has selected a method – gunshot, hanging, cutting, etc. – the probability of suicide increases the more they refine their plan – when, where, how, etc.

Thus an important follow-up question to “Have you been thinking of hurting or killing yourself?” is “Have you developed a plan for how you will end your life?”  A broader question would be, “Which means to end your life are available to you and would you consider using during a suicidal crisis?”

We ask the question as part of the ongoing assessment process (Is their plan available, lethal, and accessible?), but we also ask it as an intervention tool as well.  Namely, can we eliminate or limit their access to those named lethal means for a temporary time?

This is based on the belief that once people select a method to end their life, they are unlikely to switch to another method.  Please note I did not say they will not switch – I said they are unlikely to switch.  Means restriction is not fool proof or guaranteed, but it is a useful intervention step, especially in the short term.

Barber & Miller (2014), in their article on reducing access to lethal means, suggest several potential avenues of approach: 1) physically impeding access (e.g., gun locks, bridge barriers, restricting access to car keys); 2) reducing the lethality or toxicity of a given method (e.g., reducing carbon monoxide content of motor vehicle exhaust); or 3) reducing “cognitive access,” that is, reducing a particular method’s appeal (e.g., discouraging media coverage of an emerging suicide method).

In my next post, we’ll look at practical ways to implement reducing access to lethal means.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at criticalconcepts.org.

I’ve been writing about the Safety Plan as a brief suicide intervention, Tear up that no-harm/no-suicide contract, and we are ready to explore the fifth step, Professional and Agency Contacts to Help Resolve Suicidal Crises.

If the prior four steps are ineffective in resolving the suicidal crisis, the person in crisis is encouraged to contact a mental health professional (MHP) or helping agency.  Thus, the fifth step consists of identifying MHPs, helping agencies, or hotlines to assist the person in crisis.  List their contact information, their telephone numbers, and locations.

The list of MHPs or helping agencies can be prioritized. If the person is actively engaged in mental health treatment, the Safety Plan should include the name and phone number of this provider. However, the Safety Plan should also include other professionals or agencies who may be reached especially during non-business hours.

I strongly recommend the plan include the National Suicide Prevention Lifeline: 1-800-273-8255 (TALK).  If the person in crisis is a veteran, recommend they press 1 after they dial the other numbers.  This will take them to a person who understands veteran’s needs.

The person in crisis may be reluctant to contact MHPs and disclose their suicidal thoughts for fear of being hospitalized or rescued. The clinician should discuss the person in crisis’ expectations when they contact MHPs and helping agencies for assistance, then discuss any challenges in doing so. Are there any concerns or other obstacles that may hinder the person from contacting an MHP or helping agency? Only those MHPs whom the person is willing to contact during a crisis should be included in the Safety Plan.

In my next blog, we’ll cover the last step, Reducing the Potential for Use of Lethal Means.

If you are interested in my upcoming trainings or my new online training format, or want to review my CV, please visit my website at criticalconcepts.org.